Table 3: Techniques for female-to-male sex reassignment surgery [18, 22].

Surgical techniqueLimitationsBenefits

Metoidioplasty (metaidoioplasty)Short phallus
Very rarely capable of sexual penetration
Not always enable for voiding whilst standing
Overall complication rate less than 20%
Easy technique
Lower risk of complication
Quick recovery time
No donor-site morbidity

Phalloplasty
Radial forearm flapUrinary tract problems
Multiple stages
Stiffener required, or permanent erection if bone is used
Donor-site morbidity
Microsurgical skills required
Possible ability for sexual intercourse.
Possibly, best cosmetic result? (overall complication rate up to 40%)
Anterolateral thigh flapPossibly similar limitations to radial forearm flap
No long-term followup available
Easier to hide the donor site disfigurement
Usually harvested as a pedicle flap
Fibula flapPossibly similar limitations to radial forearm flap
Permanent erection
No recent long-term follow-up available
Microsurgical skills required
Easier to hide the donor site disfigurement
Latissimus dorsi flapUrinary tract not reconstructed
Erection function (based on muscle contraction) questionable
Donor-site morbidity
Sexual and tactile sensitivity not reported
No long-term follow-up available
Microsurgical skills required
No need of inflatable erection device
Suprapubic flap/groin flapCosmetic appearance unsatisfactory
Donor-site morbidity?
Urinary tract problem
Fully or partially sensate?
Stiffener or erection possible?
Multiple stages
If urethra is reconstructed, usually it is reconstructed in a different stage, and rarely reach the tip of the penis, but it often opens ventrally
Groin flap requires a minimum of two stages
Easy technique